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Recurrence Patterns After Resection of Colorectal Liver Metastasis are Modified by Perioperative Systemic Chemotherapy

  • Florian E. Buisman
  • Boris Galjart
  • Eric P. van der Stok
  • Vinod P. Balachandran
  • Thomas Boerner
  • Jeffrey A. Drebin
  • Dirk J. Grünhagen
  • William R. Jarnagin
  • T. Peter Kingham
  • Cornelis Verhoef
  • Micheal I. D’Angelica
  • Bas Groot KoerkampEmail author
Original Scientific Report
  • 105 Downloads

Abstract

Background

This study investigated the impact of perioperative systemic chemotherapy on the recurrence rate and pattern following resection of colorectal liver metastases.

Methods

A retrospective cohort study was conducted in two centers. Rates and patterns of recurrence and overall survival (OS) were compared between patients treated with and without perioperative systemic chemotherapy. The clinical risk score (CRS) was used to stratify patients in low risk (CRS 0–2) and high risk (CRS 3–5) of recurrence.

Results

A total of 2020 patients were included, of whom 1442 (71%) received perioperative systemic chemotherapy. The median follow-up was 88 months, and 1289 patients (64%) developed a recurrence. The recurrence pattern was independent of chemotherapy in low-risk patients: intrahepatic recurrences (30% vs. 30%, p = 0.97) and extrahepatic recurrences (38% vs. 39%, p = 0.52). In high-risk patients, no difference in intrahepatic recurrences was found (48% vs. 50%, p = 0.59). However, a lower rate of extrahepatic recurrences (43% vs. 55%, p = 0.007) was observed with perioperative systemic chemotherapy, mainly due to a reduction in pulmonary recurrences (25% vs. 35%, p = 0.007). In competing risk analysis, the cumulative incidence of extrahepatic recurrence was significantly lower with perioperative systemic chemotherapy in high-risk patients only (5-year cumulative incidence 44% vs. 59%, p < 0.001). Perioperative chemotherapy was associated with improved OS in high-risk patients (adjusted HR 0.73, 95% CI 0.57–0.94, p = 0.02), but not in low-risk patients (adjusted HR 0.99, 95% CI 0.82–1.19, p = 0.90).

Conclusions

Perioperative systemic chemotherapy had no association with intrahepatic recurrence, but was associated with fewer pulmonary recurrences and superior OS in high-risk patients only.

Notes

Funding

None.

Compliance of ethical standards

Conflict of interest

The authors have no conflict of interest.

Informed consent

No informed consent was required.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Florian E. Buisman
    • 1
  • Boris Galjart
    • 1
  • Eric P. van der Stok
    • 1
  • Vinod P. Balachandran
    • 2
  • Thomas Boerner
    • 2
  • Jeffrey A. Drebin
    • 2
  • Dirk J. Grünhagen
    • 1
  • William R. Jarnagin
    • 2
  • T. Peter Kingham
    • 2
  • Cornelis Verhoef
    • 1
  • Micheal I. D’Angelica
    • 2
  • Bas Groot Koerkamp
    • 1
    Email author
  1. 1.Department of Surgery, Erasmus MC Cancer InstituteErasmus UniversityRotterdamThe Netherlands
  2. 2.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA

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